Biomedical Engineering Reference
In-Depth Information
asking background questions if their experience is limited and/or if information is miss-
ing related to a particular disorder or condition. For example, the AT team may ask back-
ground questions seeking additional evidence on the characteristics of fragile X syndrome
or the side effects of baclofen. However, a foreground question is formulated to search for
research evidence to guide decisions.
The acronym PICO used by Sackett et al. (2000) provides a structure that includes iden-
tifying the type of
patient
or
problem
, a broadly defined
intervention
, a
comparison
interven-
tion, and an
outcome
. Experience with EBP is needed to distinguish the elements of a PICO
question and determine the level of detail regarding the intervention, comparison, and
outcome components of the question. Consider the following PICO questions supporting
the goal to reduce the uncertainty of a decision about an AT solution:
• For a college student with cerebral palsy (P), will word prediction (I) or ortho-
graphic word selection (C) result in the greatest increase in selection rate (bits per
second) and average communication rate (words per minute) (O)
for generating
writing assignments for college classes and personal correspondence?
• For an adult with severe Broca's aphasia (P), would computer-based AT using a
visual scene user interface for word retrieval (I) or a grid-type interface with core
and activity rows (C) lead to the greater increases in accurate word order and
utterance length (O) for conversations with family?
• For a child with autism (P), what approach would result in greater gains in accu-
rate word recognition and word fluency (O) during oral reading tasks: computer-
based AT software based on a four-block model (I) or traditional instruction with
no technology support (C)?
In each of the above examples, the knowledge and skills of the SLP can be tapped into
pinpoint the elements and extent of detail of the question. If the client is a child with ASD
(as above), is that enough detail for the question? Detailed client information regarding
emergent or elementary literacy skills may be added. Perhaps the (P) could indicate that
the child was at the “phonology-metaphonology” transition of language acquisition? The
SLP may have knowledge and skills about specific interventions and recommendations
about comparison strategies that include posing the alternative as “no treatment.” Finally,
the SLP can recommend outcome elements that match the intervention, are measurable,
and are considered critical to optimizing communication.
Once the best or most meaningful question is formulated, the search continues to locate
and appraise the external evidence. McKibbon et el. (1995) emphasize that the best research-
derived evidence is valid, important, and applicable. Research evidence is appraised based
on levels of evidence. SLPs are trained to identify not only the strength of the evidence, but
to also use the acronym POEM to evaluate if the evidence is patient-oriented evidence that
matters (Dollaghan 2007). However, SLPs realize that POEM on treatment effectiveness for
individuals with significant disabilities frequently is limited. Therefore, at times, perhaps
a single case study may be the best evidence to support an AT decision.
EBP does not rely on external evidence alone. The clinical and personal evidence gath-
ered by the SLP are the two other EBP components required to guide decision-making.
Additional clinical and personal evidence (e.g., quantitative and qualitative data) may be
needed as the AT team evaluates all of the evidence. At this point, a functional analysis and
psycho-socio-environmental evaluations that address the specific context of use are con-
ducted. Note how the EBP model (Figure 14.2) depicts a continuous loop in collecting and
